Autism Spectrum Disorder Updates in 6 Areas

Recent years have seen some real progress in key areas of research on autism spectrum disorder (ASD): from possible genetic causes, to effective treatments for common symptoms and clinical problems, to promoting success for young people with ASD entering college. Updates on these and other advances in ASD research are presented in the March special issue of Harvard Review of Psychiatry. The following is a very brief summary.

Genetics. Over the last few years, there have been tremendous advances in understanding the genetic basis of ASD. Literally hundreds of genes with varying degrees of ASD risk have been identified. Many of these genes also appear to be risk factors for related neurodevelopmental disorders and psychiatric problems. And of course when this many genes are potentially involved, the possibility of multiple individual disorders instead of one over arching category increases. While many unanswered questions remain, it may soon be possible to make specific genetic diagnoses in children with ASD.

Psychoactive medications. Despite limited evidence, psychotropic drugs are widely used to manage behavior problems and mental health disorders in children with ASD. For medication classes — including antidepressants and stimulants — effectiveness may differ for youth versus adults with ASD. New treatments affecting specific neurotransmitters and the hormone oxytocin are under development, and may help in targeting the “core symptoms” of ASD.

Obesity. Obesity is a common problem with a big impact on the health of children with ASD. Some ASD-related genes may also promote obesity; the same is true for antipsychotic drugs used to help manage behavior problems. Other contributing factors may include sleep disorders and barriers to getting enough exercise. Childhood obesity and related health issues may be a “significant threat” to the health and quality of life of children with ASD.

Gastrointestinal issues. Children with ASD also have high rates of gastrointestinal symptoms and disorders. Some genes linked to ASD may also play a role in gastrointestinal disturbances, with a possible link to immune system dysfunction. Increasingly there’s emerging evidence of a potential “gut-brain” connection, with gastrointestinal dysfunction contributing to the development or severity of ASD symptoms.

Sensory symptoms. Children with ASD have various abnormalities of sensory function, including both over- and under-responsivity as well as “sensory seeking behavior.” Although the neurobiology of these sensory symptoms remains unclear, some researchers suggest they are related to known abnormalities of brain structure and function. Recent studies show that sensory symptoms are related to other ASD-related symptoms and behaviors; more research is needed to demonstrate the effectiveness of “sensory integration therapy” and other occupational therapy approaches.

Preparing for college. The final article highlights the need for new approaches to meeting the needs of “high-functioning” ASD patients entering college. Students “on the spectrum” transitioning to college are at risk of both academic and social problems, and may benefit from accommodation and supports. Based on a growing body of research, a set of recommendations for developing more effective transition plans for children with ASD are proposed.

Our own experience at The Dubin Clinic is that while it may at times be very difficult to address the primary dysfunctions seen in ASD, there are secondary dysfunctions that are quite treatable and without medication. I am referring to such things as anxiety, impulsivity, explosive disruptions, and an over reactive nervous system. We find that these generally and quite rapidly improve using Direct Neurofeedback. The impact this has on their lives and the lives of their families is tremendous. More research is clearly indicated.